California

Insurance Code

4,514 sections, each with the official text and a plain-English explanation of what it means for you.

• § 12401.10 — Nothing in this article shall require the filing of rates by title insurers for reinsurance contracts or agreements or policies of excess coinsurance.
• § 12401.2 — Every title insurer, underwritten title company and controlled escrow company shall establish basic classifications of coverages and services to be used as the basis for determining rates.
• § 12401.3 — The following standards shall apply to the making and use of rates pertaining to all the business of title insurance to which the provisions of this article are applicable: (a) Rates shall not be exce
• § 12401.4 — In order to further uniform administration of rate regulatory laws, the commissioner and every person or entity in the business of title insurance and every advisory organization in this state may exc
• § 12401.5 — As a further aid to uniform administration of rate regulatory laws of this state, the commissioner may prescribe by reasonable rules and regulations: (a) For the annual reporting of financial data rel
• § 12401.6 — Nothing in this article shall be construed to prohibit concert of action between entities under the same general management and control.
• § 12401.7 — No title insurer, underwritten title company or controlled escrow company shall use any rate in the business of title insurance prior to its effective date nor prior to the filing with respect to such
• § 12401.71 — (a) Notwithstanding Sections 12401.
• § 12401.8 — Charges in excess of those set forth in a rate filing which has become effective may be made when such filing includes a statement that such charges may be made in the event unusual insurance risks ar
• § 12401.9 — The schedules of rates which are required to be filed with the commissioner under the provisions of Section 12401.
• § 12402 — No advisory organization shall conduct its operations in this state without first filing with the commissioner: (a) a copy of its constitution, articles of agreement or association or certificate of i
• § 12402.1 — Every advisory organization shall adopt bylaws or rules and regulations which will: (a) Permit any person or entity in the business of title insurance in this state to become a member at a reasonable
• § 12402.2 — No bylaw or rule or regulation required by Section 12402.
• § 12404 — (a) It is unlawful for any title insurer, underwritten title company or controlled escrow company to pay, directly or indirectly, any commission, compensation, or other consideration to any person as
• § 12404.1 — The furnishing of a preliminary report by any title insurer, controlled escrow company or underwritten title company, without charge to any person, shall constitute a violation of Section 12404.
• § 12404.5 — As used in this section “personal or controlled insurance” means a policy of title insurance, or insurance as to the identity, due execution and validity of any note or bond secured by mortage, or the
• § 12405 — No title insurer, no controlled escrow company, and no underwritten title company shall make any rebate of any portion of the fee or charge shown by the schedule required by Section 12401.
• § 12405.7 — In addition to other acts prohibited by this article, no controlled escrow company or title insurer or other person engaged in the business of selling or furnishing to the public, directly or indirect
• § 12406 — No title insurer shall issue any title policy in any transaction in connection with which it or any person which is a controlled escrow company or underwritten title company by reason of its relations
• § 12406.5 — (a) The commissioner shall develop, publish, and disseminate a brochure for consumers who are required to buy title insurance as part of a residential real estate transaction.
• § 12407 — The commissioner, if he has reason to believe that any controlled escrow company or any underwritten title company has violated or is violating any of the provisions of this article, has the power and
• § 12408 — Every title insurer shall include in its annual statement furnished the commissioner pursuant to Article 10 (commencing with Section 900), Chapter 1, Part 2, Division 1 of this code, the name of each
• § 12408.1 — Whenever a title insurer terminates its underwriting agreement with any underwritten title company, it shall at the same time give notice of the termination to the commissioner.
• § 12408.5 — (a) Notwithstanding any other provision of this article no title insurer, no controlled escrow company, and no underwritten title company shall pay any commission for the solicitation or negotiation o
• § 12409 — (a) Every title insurer, controlled escrow company, and underwritten title company which pays any commission or which makes any unlawful rebate in violation of this article shall be liable to the peop
• § 1241 — (a) Subject to the limitation in Section 1242, and except for those foreign investments permitted under Section 1192.
• § 1241.1 — (a) No domestic insurer shall acquire any investment respecting a foreign jurisdiction, or any investment denominated in the currency of that foreign jurisdiction, if that jurisdiction is designated a
• § 1241.2 — (a) The Legislature finds and declares all of the following: (1) The federal Securities and Exchange Commission has determined that business activities in foreign states sponsoring terrorism, such as
• § 12410 — In enforcing any of the provisions of this article, the commissioner shall be entitled to the remedies provided for in Section 12928.
• § 12411 — The commissioner may after a hearing suspend or revoke the certificate of authority of any title insurer or the license of any underwritten title company licensed pursuant to the provisions of Section
• § 12412 — Nothing in this article prohibits the division of fees or charges, for work and services actually performed, between title insurers or between title insurers and underwritten title companies or betwee
• § 12413.1 — No title insurance company, controlled escrow company, or underwritten title company shall disburse funds from an escrow account until the day established by the following: (a) Except for funds deposi
• § 12413.2 — Any item or draft received by a title insurance company, controlled escrow company, or underwritten title company in connection with any escrow shall be deposited in, or submitted for collection to, a
• § 12413.5 — All funds received in connection with any escrow conducted by a title insurance company, controlled escrow company, or underwritten title company shall be deposited in a separate depository account in
• § 12414.13 — Any person aggrieved by any rate charged, rating plan or rating system followed or adopted by a title insurer, underwritten title company, or controlled escrow company may request such person or entit
• § 12414.14 — If after examination of a title insurer, an underwritten title company, or a controlled escrow company, or upon the basis of other information, or upon sufficient complaint as provided in Section 1241
• § 12414.15 — If the commissioner has good cause to believe such noncompliance to be willful, or if within the period prescribed by the commissioner in the notice required by Section 12414.
• § 12414.16 — If after a hearing pursuant to Section 12414.
• § 12414.17 — In addition to other penalties provided in this code, the commissioner may suspend or revoke, in whole or in part, the authority of any person or entity to engage in the business of title insurance up
• § 12414.18 — Except as otherwise provided in this chapter, all proceedings in connection with the denial, suspension, or revocation of a license or certificate of authority under this chapter shall be conducted in
• § 12414.19 — Any finding, determination, rule, ruling, or order made by the commissioner under Article 5.
• § 12414.20 — The commissioner may, as often as may be reasonable and necessary, make or cause to be made an examination of any advisory organization for the business of title insurance in this state.
• § 12414.21 — The commissioner may, pursuant to reasonable rules and regulations which he shall prescribe, make or cause to be made an examination of every title insurer, underwritten title company or controlled es
• § 12414.22 — The officers, managers, agents, and employees of any advisory organization, title insurer, underwritten title company, or controlled escrow company may be examined at any time under oath and shall exh
• § 12414.23 — The reasonable cost of any examination authorized by this article shall be paid by the advisory organization, title insurer, underwritten title company, or controlled escrow company to be examined.
• § 12414.24 — No person, title insurer, underwritten title company, controlled escrow company, or advisory organization shall willfully withhold information from, or knowingly give false or misleading information t
• § 12414.25 — (a) Any person, title insurer, underwritten title company, or controlled escrow company who fails to comply with a final order of the commissioner under this chapter shall be liable to the state in an
• § 12414.26 — No act done, action taken, or agreement made pursuant to the authority conferred by Article 5.
• § 12414.27 — Commencing 120 days following January 1, 1974, no title insurer, underwritten title company or controlled escrow company shall charge for any title policy or service in connection with the business of
• § 12414.28 — All title policies issued by title insurers shall be subscribed by the president or a vice president and by the secretary or an assistant secretary of the corporation.
• § 12414.29 — The administration and enforcement of Article 5.
• § 12414.30 — (a) When constituting an offer to issue an owner’s policy of title insurance, a preliminary report shall incorporate the following statement, in bold print on front of the preliminary report: “Please
• § 12414.31 — (a) (1) Whenever the commissioner takes any formal enforcement or disciplinary action directly against an employee of a title insurer, underwritten title company, or controlled escrow company, for mal
• § 12415 — It is the intent of the Legislature that certificated title insurers and licensed underwritten title companies, as defined in Section 12340.
• § 12416 — Each certificated title insurer possessing a certificate of authority of indefinite term pursuant to Section 701 shall owe and pay an annual renewal fee of nine hundred eighty-eight dollars ($988).
• § 12417 — The annual renewal fee provided by this article is not a tax but a charge for services to be rendered.
• § 12418 — (a) No person shall be employed as a title marketing representative in this state unless the person holds a valid “certificate of registration” as a title marketing representative issued by the commis
• § 12418.1 — (a) A certificate of registration as a title marketing representative shall be applied for and renewed by filing with the commissioner a written application.
• § 12418.2 — (a) An applicant or holder of a certificate of registration as a title marketing representative is not required to pass a qualifying examination, and is exempt from prelicensing and continuing educati
• § 12418.3 — (a) Each certificate of registration issued under this article shall be for a three-year period beginning on the date the certificate is issued.
• § 12418.4 — (a) Sections 1667, 1668, 1669, 1670, 1729, 1729.
• § 1242 — (a) (1) Except as otherwise specified in Section 1241, a domestic insurer shall not acquire directly or indirectly through an investment subsidiary, an investment under Section 1241 if, as a result of
• § 125 — This chapter shall be known and may be cited as the California Risk Retention Act of 1991.
• § 1250 — When any domestic incorporated insurer has, pursuant to the laws of this State, invested any of its funds in purchases of, or loans upon, the stock or obligations of a corporation or of a nation, stat
• § 1251 — A stock, bond or other evidence of debt if in default as to principal or interest, or if not amply secured, shall not be valued as an asset of the insurer above its market value.
• § 1252 — All bonds or other evidences of debt held by an admitted incorporated insurer if amply secured and if not in default as to principal or interest may, in the discretion of the commissioner, be valued a
• § 1253 — Any such insurer may report such bonds or other evidence of debt at market value or book value, but in no event at an aggregate value exceeding the aggregate of the values calculated according to the
• § 1254 — Any asset of an insurer which is found by the commissioner to be insolvent or threatened with insolvency shall be reduced in value, if necessary, to reflect its proper value.
• § 126 — The Legislature finds and declares that the provisions of this chapter are for the purpose of providing a means for a bona fide for-profit or nonprofit association or individual business to insure aga
• § 1260 — Incorporated insurers or reciprocal insurers who are members of what is commonly known as a “group” or “fleet” may enter into reinsurance transactions between members of the same “group” or “fleet” un
• § 12640.01 — This chapter may be cited as the Mortgage Guaranty Insurance Act.
• § 12640.02 — The definitions set forth in this article shall govern the construction of the terms used in this chapter but shall not affect any other provisions of this code.
• § 12640.03 — An insurer shall not transact the business of mortgage guaranty insurance unless it has paid-in capital of at least one million dollars ($1,000,000) and paid-in surplus of at least one million dollars
• § 12640.04 — (a) In addition to the paid-in capital and surplus provided in Section 12640.
• § 12640.05 — (a) A mortgage guaranty insurer shall maintain a policyholders surplus in an amount not less than the amount required by this section.
• § 12640.06 — A mortgage guaranty insurer shall not declare any dividends except from undivided profits remaining on hand over and above the aggregate of its paid-in capital, paid-in surplus and contingency reserve
• § 12640.07 — (a) Mortgage guaranty insurance may be transacted in this state only by a stock or mutual casualty insurer holding a certificate of authority for the transaction of the insurance pursuant to this chap
• § 12640.08 — A mortgage guaranty insurer shall not insure loans secured by properties in a single housing tract or a contiguous tract in excess of ten (10) percent of the insurer’s policyholders surplus.
• § 12640.09 — (a) A mortgage guaranty insurer shall limit its coverage for the class of insurance defined in paragraph (3) of subdivision (a) of Section 12640.
• § 12640.091 — (a) In order to qualify as a segregated trust under subdivision (d) of Section 12640.
• § 12640.095 — A mortgage guaranty insurer transacting the class of insurance defined in paragraph (2) of subdivision (a) of Section 12640.
• § 12640.10 — (a) An insurer that anywhere transacts any class of insurance other than mortgage guaranty insurance defined in paragraphs (1), (3), and (4) of subdivision (a) of Section 12640.
• § 12640.11 — (a) Nothing in this chapter (commencing with Section 12640.
• § 12640.12 — Every mortgage guaranty insurer shall adopt, print and make available a schedule of premium charges for mortgage guaranty insurance policies.
• § 12640.13 — (a) No mortgage guaranty insurer shall pay to any person who is acting as agent, representative, attorney or employee of the owner, mortgagee of the prospective owner, or mortgagee of the real propert
• § 12640.14 — No mortgage guaranty insurer shall make any rebate of any portion of the premium charge shown by the schedule required by Section 12640.
• § 12640.145 — No mortgage guaranty insurer shall pay any compensation to any person for transacting insurance for or with it based in whole or in part upon a commission basis unless such person is licensed pursuant
• § 12640.15 — The commissioner may after a hearing suspend or revoke the certificate of authority of any mortgage guaranty insurer which, after 10 days written notice from the commissioner requiring it to cease and
• § 12640.16 — (a) The provisions of Article 10 (commencing with Section 900), Chapter 1, Part 2, Division 1, relating to financial statements, shall apply to mortgage guaranty insurers.
• § 12640.17 — All the applicable provisions of this code and of other statutes of this state, except as the same may be in conflict herewith, shall apply to the operation and conduct of the business authorized by t
• § 12640.18 — The commissioner may adopt, pursuant to Chapter 3.
• § 12640.19 — No bank, savings and loan association or insurance company, any of whose authorized real estate securities are insured by mortgage guaranty insurance pursuant to this chapter (commencing with Section
• § 12640.20 — The commissioner shall collect in advance a fee of four hundred seventy-two dollars ($472) from each mortgage guaranty insurer for the examination and analysis of the reinsurance contracts, final pros
• § 12660 — Any person who in this state engages in the business of guaranteeing or insuring land values, or who solicits or negotiates in this state for the purpose of, or in any manner aids, any person within o
• § 12661 — The commissioner may suspend or revoke or may deny any license or certificate issued under any provision of this code in any case where the applicant or licensee or certificate holder has committed an
• § 12670 — It is the intent of the Legislature to ensure that persons covered by a group policy, who become ineligible for that coverage have access to benefits pursuant to this part by requiring employers, empl
• § 12671 — As used in this part, the following terms have the following meanings: (a) “Group policy” means a group health insurance policy providing medical, hospital, surgical, major medical, or comprehensive m
• § 12672 — (a) Any group policy issued, amended, or renewed in this state on or after January 1, 1983, which provides insurance for employees or members on an expense-incurred or service basis, other than for a
• § 12673 — Conversion coverage shall be required to be made available to an employee or member unless such coverage under the group policy terminates for one or more of the following reasons: (a) The group polic
• § 12674 — A converted policy shall be issued effective on the day following the termination of coverage under the group policy if written application and the first premium payment for the conversion policy are
• § 12675 — The premium for the conversion coverage shall be determined in accordance with the insurer’s rates applicable to the age and class of risk of each person to be covered and to the type and amount of co
• § 12676 — The conversion coverage shall cover the employee or member and his or her dependents who were covered by the group policy on the date of termination of coverage.
• § 12677 — The insurer shall not be required to issue a converted policy covering any person if such person is entitled to be covered by Medicare.
• § 12678 — The insurer shall not be required to issue a converted policy covering any person if any of the following exists: (a) The person is covered for similar benefits by another individual policy.
• § 12679 — A converted policy may provide that the insurer may at any time request information from any person covered thereunder as to whether he or she is covered for the similar benefits described in Section
• § 12680 — If conversion coverage is issued and benefits are also provided to a person under Section 12678, the insurer may limit the conversion benefits provided or available for such person so that such conver
• § 12681 — An insurer shall not be required to issue a converted policy providing benefits in excess of those provided under the group policy from which conversion is made.
• § 12682 — The converted policy shall not exclude, as a preexisting condition, any condition covered by the group policy.
• § 12682.1 — This section does not apply to a policy that primarily or solely supplements Medicare.
• § 12682.2 — (a) (1) At least 60 days prior to the policy renewal date, an insurer that does not otherwise issue individual health insurance policies shall issue the notice described in paragraph (2) to any policy
• § 12683 — Subject to the provisions and conditions of this part, if the group policy from which conversion is made covers the employee or member for basic hospital or surgical expense, the employee or member sh
• § 12684 — Subject to the provisions and conditions of this part, if the group policy from which conversion is made provides the employee or member with major medical or comprehensive medical insurance, the empl
• § 12685 — The insurer may, at its option, offer alternative plans for group health conversion in addition to those required by this part.
• § 12686 — (a) In the event coverage would be continued under a group policy on an employee or member following his or her retirement prior to the time he or she is or could be covered by Medicare, the employee
• § 12687 — Notwithstanding any other provision in this part, whenever an employee or member chooses among two or more conversion policies, such choice shall be made within 31 days from the last date when the emp
• § 12688 — Notwithstanding any provision in this part to the contrary, a hospital service corporation or any insurer which customarily offers individual conversion coverage on a service basis may, in lieu of the
• § 12689 — A notification of the conversion coverage shall be included in each certificate of coverage or other legally required document explaining coverage; provided, however, that it shall be the sole respons
• § 12690 — Nothing in this part shall prohibit insurers from establishing one or more pools from which the converted policies provided for on this part may be issued.
• § 12691 — A converted policy which is delivered in a jurisdiction other than this state may be in a form which could be delivered in such jurisdiction as a converted policy had the group policy been issued in s
• § 12692 — On and after January 1, 1985, every insurer and nonprofit hospital service plan issuing group disability insurance which covers hospital, medical, or surgical expenses shall offer to group policyholde
• § 12692.5 — Notwithstanding any other provision of this part, Sections 12672, 12673, 12674, 12675, 12676, 12677, 12678, 12679, 12680, 12681, 12682, 12683, 12684, 12685, 12686, 12687, 12688, 12689, 12690, 12691, a
• § 12693 — The Legislature declares all of the following: (a) Approximately 1.
• § 12693.01 — For purposes of this part, the definitions contained in this chapter shall govern the construction of this part, unless the context requires otherwise.
• § 12693.02 — (a) “Applicant” means a person over the age of 18 years who is a natural or adoptive parent; a legal guardian; or a caretaker relative, foster parent, or stepparent with whom the child resides, who ap
• § 12693.03 — “Board” means the Managed Risk Medical Insurance Board.
• § 12693.04 — “Child” means a person who is under 19 years of age who is eligible for the program pursuant to Chapter 9 (commencing with Section 12693.
• § 12693.045 — “Community provider plan” means that participating health plan in each geographic area that has been designated by the board as having the highest percentage of traditional and safety net providers in
• § 12693.05 — “County organized health system” means a health care organization that contracts with the State Department of Health Services to provide comprehensive health care to all eligible Medi-Cal beneficiarie
• § 12693.06 — “Family contribution” means the cost to an applicant to enable herself or himself or an eligible child or children to enroll in and participate in the program.
• § 12693.065 — “Family value package” means the combination of participating health, dental, and vision plans available to subscribers in each geographic area offering the lowest prices to the program.
• § 12693.07 — “Fund” means the Healthy Families Fund.
• § 12693.08 — “Local initiative” means a prepaid health plan that is organized by, or designated by, a county government or county governments, or organized by stakeholders, of a region designated by the department
• § 12693.09 — “Participating dental plan” means any of the following plans that is lawfully engaged in providing, arranging, paying for, or reimbursing the cost of personal dental services under insurance policies
• § 12693.10 — “Participating health plan” means any of the following plans that is lawfully engaged in providing, arranging, paying for, or reimbursing the cost of personal health care services under insurance poli
• § 12693.105 — A health care service plan, as defined in subdivision (b) of Section 12693.
• § 12693.11 — “Participating vision care plan” means any of the following plans that is lawfully engaged in providing, arranging, paying for, or reimbursing the cost of personal vision services under insurance poli
• § 12693.12 — “Program” means the Healthy Families Program, which includes a purchasing pool providing health coverage for children in families without access to affordable employer based dependent coverage and a p
• § 12693.13 — “Purchasing credit member” means an applicant 18 years of age or a child who is eligible for and participates in the purchasing credit component of the program.
• § 12693.14 — “Subscriber” means an applicant 18 years of age or a child who is eligible for and participates in the purchasing pool component of the program.
• § 12693.15 — “Supplemental coverage” means coverage purchased by the program from (a) a private health insurer holding a valid outstanding certificate of authority from the Insurance Commissioner, or (b) a health
• § 12693.16 — “Geographic managed care plan” means an entity that is operating pursuant to a contract entered into under Article 2.
• § 12693.17 — “Family contribution sponsor” means a person or entity that pays the family contribution on behalf of an applicant for any period of 12 consecutive months and, notwithstanding Section 12693.
• § 12693.20 — The Healthy Families Program is hereby created and shall be administered by the Managed Risk Medical Insurance Board.
• § 12693.21 — The board may do all of the following consistent with the standards in this part: (a) Determine eligibility criteria for the program.
• § 12693.22 — During the 2009–10 and 2010–11 fiscal years, the adoption and readoption of regulations to modify health, dental, and vision benefits or otherwise modify program requirements and operations consistent
• § 12693.23 — Until July 1, 2012, the adoption and readoption of regulations to implement subdivision (q) of Section 12693.
• § 12693.25 — The board may use a purchasing pool model, issuance of purchasing credits, supplemental coverage, or other means as appropriate to meet the purposes of this part.
• § 12693.26 — (a) The board shall establish a purchasing pool for coverage of program subscribers to enable applicants without access to affordable and comprehensive employer-sponsored dependent coverage to provide
• § 12693.27 — (a) The board shall develop a purchasing credit mechanism to enable applicants with access to affordable and comprehensive employer-sponsored dependent coverage to have an eligible child enrolled in t
• § 12693.271 — (a) The Legislature finds and declares that the state faces a fiscal crisis that requires unprecedented measures to reduce General Fund expenditures.
• § 12693.28 — The program shall be administered without regard to gender, gender identity, gender expression, race, creed, color, sexual orientation, health status, disability, or occupation.
• § 12693.29 — (a) The board shall use appropriate and efficient means to notify families of the availability of health coverage from the program.
• § 12693.30 — (a) The board shall assure that written enrollment information issued or provided by the program is available to program subscribers and applicants in each of the languages identified pursuant to Chap
• § 12693.31 — No participating health, dental, or vision plan shall, in an area served by the program, directly, or through an employee, agent, or contractor, provide an applicant, or a child with any marketing mat
• § 12693.32 — (a) The board may pay designated individuals or organizations an application assistance fee, if the individual or organization assists an applicant to complete the program application, and the applica
• § 12693.325 — (a) (1) Notwithstanding any provision of this chapter, a participating health, dental, or vision plan that is licensed and in good standing as required by subdivision (b) of Section 12693.
• § 12693.326 — Notwithstanding any other provision of this part, a new subscriber in the program shall be allowed to switch his or her choice of plans once within the first three months of coverage for any reason.
• § 12693.33 — To the extent feasible and permissible under federal law and with receipt of necessary federal approvals, the State Department of Health Services and the board shall develop a joint Medi-Cal and progr
• § 12693.34 — (a) The board may establish geographic areas within which participating health, dental, and vision plans may offer coverage to subscribers.
• § 12693.35 — Participating health, dental, and vision plans shall have, but need not be limited to, all of the following operating characteristics satisfactory to the board in consultation with the plan’s licensin
• § 12693.36 — (a) Notwithstanding any other provision of law, the board shall not be subject to licensure or regulation by the Department of Insurance or the Department of Managed Health Care, as the case may be.
• § 12693.37 — (a) The board shall contract with a broad range of health plans in an area, if available, to ensure that subscribers have a choice from among a reasonable number and types of competing health plans.
• § 12693.38 — (a) The board shall contract with a sufficient number of dental and vision plans to assure that dental and vision benefits are available to all subscribers.
• § 12693.39 — The board shall establish a process for determining which employer-sponsored health plans are eligible to receive a purchasing credit issued by the program.
• § 12693.40 — The board shall contract with health plans to provide coverage supplemental to that provided by an applicant’s or applicant’s spouse’s employer-sponsored health plan for the purchasing credit member,
• § 12693.41 — (a) The board shall consult and coordinate with the State Department of Health Services in implementing a preenrollment program into the Healthy Families Program or the Medi-Cal program pursuant to su
• § 12693.42 — Any purchasing credit issued by the board, or a contractor acting on behalf of the board, pursuant to this part shall have an overall cost to the program no greater than the cost to the program to enr
• § 12693.43 — (a) Applicants applying to the purchasing pool shall agree to pay family contributions, unless the applicant has a family contribution sponsor.
• § 12693.44 — (a) The board shall establish family contribution amounts for purchasing credit members that are equivalent to the amounts charged to subscribers participating in the purchasing pool portion of the pr
• § 12693.45 — (a) After two consecutive months of nonpayment of family contributions by an applicant, and a reasonable written notice period of no less than 30 days is provided to the applicant, subscribers or purc
• § 12693.46 — The board may prohibit applicants who drop coverage after enrolling in the pool from reenrollment in the program for up to six months.
• § 12693.47 — The program may place a lien on compensation or benefits, recovered or recoverable by a subscriber or applicant from any party or parties responsible for the compensation or benefits for which benefit
• § 12693.48 — The board may adjust payments made to a participating health plan if the board finds that the plan has a significantly disproportionate share of high- or low-risk subscribers.
• § 12693.49 — (a) When an applicant is dissatisfied with any action or inaction of a participating plan in which a subscriber is enrolled through the purchasing pool, the applicant shall first attempt to resolve th
• § 12693.50 — (a) The board shall consult and coordinate with the State Department of Health Services to implement the Medi-Cal to Healthy Families Accelerated Enrollment program pursuant to Section 14011.
• § 12693.51 — (a) A transfer of enrollment from one participating health plan to another may be made by a subscriber at times and under conditions as may be prescribed by regulations of the board.
• § 12693.515 — (a) Effective July 1, 2004, any subscriber who affirmatively selects, or is assigned by default to, a federally qualified health center, as defined by Section 1396(d)( l )(2) of Title 42 of the United
• § 12693.52 — The board may negotiate or arrange for stop-loss insurance coverage that limits the program’s fiscal responsibility for the total costs of health services provided to program subscribers, or arrange f
• § 12693.53 — The board shall develop and utilize appropriate cost containment measures to maximize the coverage offered under the program.
• § 12693.54 — A contract entered pursuant to this part shall be exempt from any provision of law relating to competitive bidding, and shall be exempt from the review or approval of any division of the Department of
• § 12693.55 — (a) A health care provider who is furnished documentation of a person’s enrollment in the program shall not seek reimbursement nor attempt to obtain payment for any covered services provided to that p
• § 12693.60 — (a) Coverage provided to subscribers shall meet the federal coverage requirements in Section 2103 of Title XXI of the Social Security Act.
• § 12693.61 — The following provisions apply for subscribers who have been identified by the participating health plans as potentially seriously emotionally disturbed.
• § 12693.615 — (a) The board shall establish the required subscriber copayment levels for specific benefits consistent with the limitations of Section 2103 of Title XXI of the Social Security Act.
• § 12693.62 — Notwithstanding any other provision of law, for a subscriber who is determined by the California Children’s Services Program to be eligible for benefits under the program pursuant to Article 5 (commen
• § 12693.63 — (a) The board shall determine the dental benefits to be provided to subscribers by the program.
• § 12693.64 — Notwithstanding any other provision of law, for a subscriber who is determined by the California Children’s Services Program to be eligible for benefits under the program pursuant to Article 5 (commen
• § 12693.65 — (a) Vision benefits shall be provided to subscribers and shall meet the federal coverage requirements in Section 2103 of Title XXI of the Social Security Act.
• § 12693.66 — Notwithstanding any other provision of law, for a subscriber who is determined by the California Children’s Services Program to be eligible for benefits under the program pursuant to Article 5 (commen
• § 12693.68 — The board shall encourage all plans, including those receiving purchasing credits, that provide services under the program to have viable protocols for screening and referring children needing supplem
• § 12693.69 — A child enrolled in the Healthy Families Program who has a medical condition that is eligible for services pursuant to the California Children’s Services Program, and whose family is not financially e
• § 12693.70 — To be eligible to participate in the program, an applicant shall meet all of the following requirements: (a) Be an applicant applying on behalf of an eligible child, which means a child who is all of
• § 12693.71 — (a) The board shall monitor applications to determine whether employers and employees have dropped employer-sponsored dependent coverage in order to participate in the program.
• § 12693.72 — (a) The board may disapprove an application if it is determined that the children to be covered under the application were covered by an individual health care service plan contract or individual disa
• § 12693.73 — Notwithstanding any other provision of law, children excluded from coverage under Title XXI of the Social Security Act are not eligible for coverage under the program, except as specified in clause (i
• § 12693.74 — (a) To the extent federal financial participation is available, and subject to subdivision (e), the child shall remain continuously eligible for the program up to five years of age.
• § 12693.75 — (a) The program shall make use of a simple and easy to understand mail-in application process.
• § 12693.755 — (a) Subject to subdivision (b), commencing four months after the initial federal approval is obtained pursuant to the waiver described in subdivision (b), the board shall expand eligibility under this
• § 12693.76 — (a) Notwithstanding any other provision of law, a child who meets the definition of the term defined in subsection (b) or (c) of Section 1641 of Title 8 of the United States Code shall not be determin
• § 12693.765 — (a) Notwithstanding any other provision of law and subject to subdivision (b), a child described in clause (ii) of subparagraph (A) of paragraph (6) of subdivision (a) of Section 12693.